Accidental falls are the second leading cause of death worldwide. In the United States alone, they accounted for 19,656 deaths in the year 2005 (World Health Organization, 2006). Non-fatal falls have many adverse side effects, including high medical expenses related to hospitalizations and subsequent therapy, as well as decreased quality of life. According to the Center for Disease Control (CDC) (2010), the cost of fatal falls in the U.S. in 2000 totaled 179 million dollars, while non-fatal falls cost an additional 19 billion dollars. Declines in quality of life can result from a loss of independence resulting from diminished mobility, physical fitness and levels of activity that may occur after a fall. These costs, as well as the number of individuals experiencing falls are predicted to increase, as the baby boomer generation approaches older adulthood. For these reasons, falls have been considered a major health concern in the United States, and are only anticipated to increase in frequency.
Prior research (Oddsson et al., European Review of Aging and Physical Activity, 4: 15-23. 2007; Talbot et al., BMC Public Health, 5:86, 2005) has identified declines in balance as a leading factor contributing to falls. Balance may be defined as the “ . . . ability to maintain a functional posture through motor actions that distribute weight evenly around the body's center of gravity” (Jacobs and Jacobs, Quick Reference Dictionary for Occupational Therapy, p. 23, 2009). Not only is balance essential for the prevention of falls, but a deficit in balance can impact an individual's ability to perform activities of daily living (ADL) (Blum and Korner-Bitensky, Physical Therapy, 88(5): 559-566, 2008). Therefore, it may be important to identify balance deficits displayed by an individual because of the negative impact they may have on the individuals' overall function.
There are many balance assessment tools currently utilized in clinical practice that detect the presence of balance deficits and evaluate the effectiveness of treatment interventions. The Berg Balance Scale (BBS) has been described as the “gold standard” in measuring functional balance performance. The BBS assesses gross motor reaching movement patterns and provides a numerical assessment of a person's balance performance during a series of increasingly more complex functional movements (Blum and Korner-Bitensky, 2008; Smith et al., Clinical Rehabilitation, 18: 811-818, 2004). The Falls Efficacy Scale International (FES-I) is a survey questionnaire that assesses an individual's degree of concern about falling while performing ADLs. (Delbaere et al., Age and Ageing, 39: 210-216, 2010; Hotchkiss et al., American Journal of Occupational Therapy, 58: 100-103, 2004; Trader et al., Journal of Geriatric Physical Therapy, 26(3): 3-8, 2003). The Tinetti Balance Assessment Tool measures both static and dynamic balance during functional tasks that emphasize stability. Scores are assigned based on the amount of assistance the client requires during completion of specific task criteria (Sterke et al., Intergenerational Psychogeriatrics, 22(2): 254-263, 2010). The Multi-Directional Reach Test (MDRT) is an assessment used to measure an individual's anterior, posterior, right and left functional reaching limits (Winser and Kannan, Global Journal of Health Science, 3(1): 90-97, 2011).
However, there are several limitations among the most commonly used balance assessment tools. A significant limitation present in several of these assessments is that they do not examine balance while reaching and performing trunk rotation, which are both crucial elements of performing everyday tasks (Holein-Jenny et al., Ergonomics, 50(5), 2005; Smith et al., 2004; Sterke et al., 2010; Winser and Kannan, 2011). In addition, several of these tests do not identify the specific point at which the participant experiences a balance deficit during the completion of task specific patterns (Smith et al., 2004; Sterke et al., 2010). A lack of this knowledge could prevent clinicians from designing an intervention that appropriately addresses the individual's deficits in balance.
Additionally, fine motor abilities in cooperation with gross motor reaching tasks are not measured in commonly used balance assessments (Holbein-Jenny et al., 2005; Winser and Kannan, 2011). Subjectivity of the data collected in the FES-I can reduce the reliability of assessment scores, due to individual interpretations of survey questions and participants' perceived abilities (Hotchkiss et al., American Journal of Occupational Therapy, 58: 100-103, 2004; Trader et al., 2003). Finally, the BBS includes common household objects that have physical characteristics which may vary between administered tests, and may reduce reliability due to inconsistencies in instrumentation (Smith et al., 2004). The limitations in current balance assessments illustrate the need for a tool that more comprehensively addresses balance issues and relates them to functional outcomes.